Types of Medigap (Supplemental Insurance) Plans

Original Medicare pays for many, but not all, health care services and supplies. Medicare Supplement Insurance policies, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Medicare Supplement Insurance policies are also called Medigap policies. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then, your Medigap policy pays its share. You have to pay the premiums for a Medigap policy.

The chart below shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you’re responsible for the rest.

Medicare Supplement Insurance (Medigap) plans

BENEFITS

A

B

C

D

E

F *

G

K

L

M

N

Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Medicare Part B coinsurance or copayment

100%

100%

100%

100%

100%

100%

100%

50%

75%

100%

100% **

Blood (first 3 pints)

100%

100%

100%

100%

100%

100%

100%

50%

75%

100%

100%

Part A hospice care coinsurance or copayment

100%

100%

100%

100%

100%

100%

100%

50%

75%

100%

100%

Skilled nursing facility care coinsurance

100%

100%

100%

100%

100%

50%

75%

100%

100%

Part A deductible

100%

100%

100%

100%

100%

100%

50%

75%

50%

100%

Part B deductible

100%

100%

Part B excess charges

100%

100%

Foreign travel emergency (up to plan limits)

80%

80%

80%

80%

80%

Out of Pocket Limit in 2015

80%

80%

$4,940

$2,470

* Plan F also offers a high-deductible plan in some states. If you choose this option, this means you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,180 in 2015 before your policy pays anything.

** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.

What else should I know about Medicare Supplement Insurance (Medigap)?

Important facts:

You must have Part A and Part B.

You pay the private insurance company a monthly premium for your Medigap policy in addition to your monthly Part B premium that you pay to Medicare. Contact the company to find out how to pay your premium.

A Medigap policy only covers one person. Spouses must buy separate policies.

You can’t have prescription drug coverage in both your Medigap policy and a Medicare drug plan. See page 117 of the official US government Medicare handbook.

It’s important to compare Medigap policies since the costs can vary and may go up as you get older. Some states limit Medigap premium costs.

When to buy:

The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This 6-month period begins on the first day of the month in which you’re 65 or older and enrolled in Part B. (Some states have additional Open Enrollment Periods.) After this enrollment period, you may not be able to buy a Medigap policy. If you’re able to buy one, it may cost more.

If you delay enrolling in Part B because you have group health coverage based on your (or your spouse’s) current employment, your Medigap Open Enrollment Period won’t start until you sign up for Part B.

Federal law generally doesn’t require insurance companies to sell Medigap policies to people under 65. If you’re under 65, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. However, some states require Medigap insurance companies to sell Medigap policies to people under 65.

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Supplemental Medicare plans are made to suit your needs. With our help, you can choose Medicare supplements that provide only the additional coverage you require, while also cutting your out-of-pocket costs.